Model for Equitable Care and Outcomes for Remote Full Care Hemodialysis Units

Abstract

Background and objectives: Remotely located patients not living close to a nephrologist present major challenges for providing care. Various models of remotely delivered care have been developed, with a gap in knowledge regarding the outcomes of these heterogeneous models. This report describes a satellite care model for remote full-care hemodialysis units managed homogenously in the province of Manitoba, Canada, without onsite nephrologists. Survival in remotely located full-care units is compared with a large, urban full-care center with onsite nephrologists.Design, setting, participants, & measurements: Data from a Canadian provincial dialysis registry were extracted on 2663 patients between 1990 and 2005. All-cause mortality after initiation of chronic hemodialysis was assessed with Cox proportional hazards regression. Both short-term (1 year) and long-term (2 to 5 years) survival were analyzed.Results: Survival for patients receiving remotely delivered care was shown to be better than for those receiving care in the urban care center with this particular Canadian model of care. Furthermore, there was no difference when assessing short-and long-term survival. This was independent of distance from the urban center.Conclusions: Chronic hemodialysis patients receiving remotely delivered care in a specialized facility attain comparable, if not better survival outcomes than their urban counterparts with direct onsite nephrology care. This model can potentially be adapted to other underserviced areas, including increasingly larger urban centers.

An Economic Assessment Model of Rural and Remote Satellite Hemodialysis Units

“…The published literature is conflicting on this point. Some studies have reported mortality benefits[ 11 ] in association with SHD use, whereas others have suggested a mortality risk[ 6 , 12 ], or have found no impact on mortality[ 13 ]. Moreover, SHDs have been associated with improvements in health-related quality of life[ 14 – 16 ], likely related to decreased travel time[ 17 , 18 ] or decreased need for relocation and the associated negative psychosocial consequences[ 19 ].…”

Perspectives from the Kidney Health Initiative on Advancing Technologies to Facilitate Remote Monitoring of Patient Self-Care in RRT

“…Through the provision of a suite of telehealth services, patient satisfaction may increase with home therapies. Although small studies support the idea that patient satisfaction with telemedicine care for patients with ESRD will be high, further studies are needed in this domain (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33). There are potential downsides to telemedicine in terms of perceived intrusion into privacy and depersonalization that will also need to be investigated.…”

Cost-effective treatment modalities for reducing morbidity associated with chronic kidney disease

“…Potential disadvantages of remotely managed satellite units include a lack of nephrologist contact and uncertainty regarding impact on survival. Some studies have shown a mortality benefit in satellite hemodialysis units [51], and others no change or increased mortality in comparison to facility hemodialysis in larger tertiary care centers [ However, in some situations, the use of satellite hemodialysis units may not be a cost-effective treatment policy. One study found the breakeven point for fixed costs to be seven patients in a six station unit [52].…”